Charge patients £10 a time to see GP, urges doctor
Patients should be charged £10 every time they see their GP, a doctor has argued.
David Jones, a foundation year 2 doctor in diabetes and endocrinology at Worthing Hospital, said a payment for each visit would ensure people thought twice about whether they really needed to see their doctor and could raise billions of pounds.
Writing in the British Medical Journal (BMJ), he said the UK should follow the lead of Australia, which charges for GP visits.
%VIRTUAL-ArticleSidebar-NHS%"Given that the average patient visits their primary physician 5.5 times a year, a £10 fee, which most GPs would find acceptable, could raise billions of pounds," he said.
He said changes may offer other benefits too.
"These include a reduction in missed appointments, which are estimated to cost the NHS £162m a year," he said.
"They might also encourage patients to take more personal responsibility, leading to fewer people attending with conditions that they could manage themselves or that would be better managed through other primary care services (pharmacists, dentists, nurses, etc).
"This would lead to greater service availability and shorter waiting times in general practice."
He said in Australia people do not see co-payments as unethical, adding "it is the norm".
Patients in the UK already pay for prescriptions and dentistry, which showed they accepted that entirely free healthcare was not sustainable, he wrote.
He also argued that annual GP attendances per person in Australia are comparable with those in the UK, which suggests that co-payments "are unlikely to affect care seeking behaviour or overall health."
In an opposing view, Nancy Loader, a GP partner in Suffolk, said co-payments altered the doctor-patient relationship.
She added: "Co-payments can deter doctors from asking patients to return for review or deter patients from meeting your request. They can deter patients from seeing the GP as advised after medical or surgical discharge from hospital.
"They can encourage patients to collect multiple problems to discuss in a single consultation and pressure doctors to deal with them all at once. And they can encourage unnecessary prescribing or referral - 'I've paid, do as I say'."
She argued that countries that have introduced co-payments have seen "increased health disparities with no change in patient demand", and rising levels of bureaucracy.
Professor Kamila Hawthorne, vice chair of the Royal College of GPs, said: "GPs have a duty to provide healthcare to patients regardless of their ability to pay and the college is against charging patients for GP appointments - a move that would fundamentally change one of the founding principles of the NHS, that healthcare is free at the point of need.
"Even introducing a standardised fee, which is then subsidised by the Government, would undoubtedly deter many people from seeking medical help in the early stages of illness when they can be dealt with cost-effectively and efficiently in primary care, rather than requiring expensive specialist care in hospitals.
"Charging for appointments would also be a lot more complicated than it sounds - where does it stop? GPs make contact with patients in a variety of ways, would a charge just be for face to face appointments, or phone calls and emails as well? And if charges extend to house calls then there are serious safety implications to consider as GPs could be targeted for carrying cash."
